Pancreas-kidney transplantation: A game-changer for diabetic patients with advanced chronic kidney disease and hypoglycemia unawareness

Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) worldwide. DM poses a significant health challenge in the Middle East and Oman, as diabetic kidney disease (DKD) represents almost half of the cases of CKD in the country. One of the troublesome complications of DM is hypoglycemia unawareness (HU), which is attributed to autonomic failure and a lack of brain sensing to glucose deficiency. Pancreas transplantation (PT) is considered an optimal treatment option for such patients. In those with advanced CKD, this can be coupled with kidney transplantation (KT). PT can be done before or after KT. However, simultaneous pancreas and KT is also an attractive option. Furthermore, pancreatic islet cell transplantation offers a less invasive procedure with a promising therapeutic potential. This review will highlight and explore the outcomes and clinical advantages of these options and their impact on survival, HU, and quality of life. Given the clinical benefits of PT, we strongly advocate that this would be a first-line option for patients with HU that can be coupled with KT if indicated, considering that DKD is, by far, the principal contributor to CKD in Oman.